title: Integrated interdisciplinary care for patients with chronic obstructive pulmonary disease reduces emergency department visits, admissions and costs: a quality assurance study.
abstract: BACKGROUND
  Dedicated programs for the management of chronic obstructive pulmonary disease (COPD) can reduce hospitalizations and improve quality of life.
  
  
  OBJECTIVE
  To investigate whether health care utilization could be reduced by a newly developed integrated, interdisciplinary initiative that included a COPD nurse navigator who educates patients and families, transitions patients through various points of care and integrates services.
  
  
  METHODS
  The present quality assurance, pre-post study included patients followed by a COPD nurse navigator from January 25, 2010 to November 5, 2011. Information regarding emergency department visits and hospitalizations, including lengths of stay, were obtained from hospital databases. Diagnoses were classified as respiratory or nonrespiratory, and used primary and secondary hospitalization diagnoses to identify acute exacerbations of COPD (AECOPD). Paired sign tests were performed.
  
  
  RESULTS
  The sample consisted of 202 patients. Following nurse navigator intervention, significantly more patients experienced a decrease in the number of respiratory-cause emergency department visits (P<0.05), number of respiratory hospitalizations (P<0.001), total hospital days for respiratory admissions (P<0.001), number of hospitalizations with AECOPD (P<0.001) and total hospital days for admissions with AECOPD (P<0.001). Financial modelling estimated annual savings in excess of $260,000.
  
  
  CONCLUSIONS
  The present quality assurance study indicated that the implementation of an integrated interdisciplinary program for the care of patients with COPD can improve patient outcomes despite the tendency of COPD to worsen over time.
authors.forename: Esther
authors.initials: E
authors.lastname: Dajczman
authors.forename: Chantal
authors.initials: C
authors.lastname: Robitaille
authors.forename: Pierre
authors.initials: P
authors.lastname: Ernst
authors.forename: Andrew Michael
authors.initials: AM
authors.lastname: Hirsch
authors.forename: Norman
authors.initials: N
authors.lastname: Wolkove
authors.forename: David
authors.initials: D
authors.lastname: Small
authors.forename: Judy
authors.initials: J
authors.lastname: Bianco
authors.forename: Hartley
authors.initials: H
authors.lastname: Stern
authors.forename: Mark
authors.initials: M
authors.lastname: Palayew
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D010348:Patient Care Team; D062526:Patient Navigation; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000191:economics / Q000628:therapy*; D011785:Quality Assurance, Health Care